Canadian Journal of Gastroenterology最新文献

{"title":"A meta-analysis of adjuvant therapy after potentially curative treatment for hepatocellular carcinoma.","authors":"Jun Wang,&nbsp;Xiao Dong He,&nbsp;Nan Yao,&nbsp;Wen Jia Liang,&nbsp;You Cheng Zhang","doi":"10.1155/2013/417894","DOIUrl":"https://doi.org/10.1155/2013/417894","url":null,"abstract":"<p><strong>Background: </strong>The high recurrence rate of hepatocellular carcinoma (HCC) after potentially curative treatment determines the long-term prognosis.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of adjuvant therapies in patients with HCC who have undergone hepatic resection, transplantation or locoregional ablation therapy.</p><p><strong>Methods: </strong>Several databases were searched to identify randomized controlled trials (RCTs) fulfilling the predefined selection criteria. Meta-analyses were performed to estimate the effects of adjuvant therapies of any modality on recurrence-free survival (RFS) and overall survival (OS).</p><p><strong>Results: </strong>Eight adjuvant modalities were identified from 27 eligible RCTs conducted predominantly in Asian populations comparing adjuvant with no adjuvant therapy. Adjuvant chemotherapy, internal radiation and heparanase inhibitor PI-88 therapy failed to improve RFS or OS, while interferon (IFN) therapy yielded significant survival results. The findings of adjuvant vitamin analogue therapy required further examination. Adjuvant adoptive immunotherapy conferred significant benefit for RFS but not for OS. Although cancer vaccine therapy and radioimmunotherapy may improve survival after radical surgery, the results were from single, small-scale trials. Severe side effects were observed in the studies of adjuvant chemotherapy and of IFN therapy.</p><p><strong>Conclusions: </strong>Adjuvant IFN therapy can improve both RFS and OS; however, the benefits of using this agent should be weighed against its side effects. Combination of systemic and transhepatic arterial chemotherapy is not recommended for HCC after potentially curative treatment. Other adjuvant therapies produce limited success for survival. Additional RCTs with proper design are required to establish the role of adjuvant therapies for HCC.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 6","pages":"351-63"},"PeriodicalIF":2.7,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/417894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Summary of guidelines for infection prevention and control for flexible gastrointestinal endoscopy.","authors":"Lawrence Hookey, David Armstrong, Rob Enns, Anne Matlow, Harminder Singh, Jonathan Love","doi":"10.1155/2013/639518","DOIUrl":"10.1155/2013/639518","url":null,"abstract":"<p><strong>Background: </strong>High-quality processes to ensure infection prevention and control in the delivery of safe endoscopy services are essential. In 2010, the Public Health Agency of Canada and the Canadian Association of Gastroenterology (CAG) developed a Canadian guideline for the reprocessing of flexible gastrointestinal endoscopy equipment.</p><p><strong>Methods: </strong>The CAG Endoscopy Committee carefully reviewed the 2010 guidelines and prepared an executive summary.</p><p><strong>Results: </strong>Key elements relevant to infection prevention and control for flexible gastrointestinal endoscopy were highlighted for each of the recommendations included in the 2010 document. The 2010 guidelines consist of seven sections, including administrative recommendations, as well as recommendations for endoscopy and endoscopy decontamination equipment, reprocessing endoscopes and accessories, endoscopy unit design, quality management, outbreak investigation and management, and classic and variant Creutzfeldt-Jakob Disease.</p><p><strong>Discussion: </strong>The recommendations for infection prevention and control for flexible gastrointestinal endoscopy are intended for all individuals with responsibility for endoscopes in all settings where endoscopy is performed.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 6","pages":"347-50"},"PeriodicalIF":2.7,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684370/pdf/cjg27347.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology of hepatitis C in a Canadian Indigenous population.","authors":"Julia Uhanova,&nbsp;Robert B Tate,&nbsp;Douglas J Tataryn,&nbsp;Gerald Y Minuk","doi":"10.1155/2013/380963","DOIUrl":"https://doi.org/10.1155/2013/380963","url":null,"abstract":"<p><strong>Background: </strong>An estimated 1% to 1.9% of North Americans are infected with the hepatitis C virus (HCV). Although Indigenous peoples are considered to bear the highest burden, there are only limited data regarding the demographic features and epidemiology of hepatitis C in this population.</p><p><strong>Objectives: </strong>To document the demographic characteristics, rates of newly diagnosed hepatitis C cases and prevalence of HCV infection in a Canadian First Nations population, and to compare the findings with an infected non-First Nations population.</p><p><strong>Methods: </strong>A research database spanning 1991 to 2002 was developed, linking records from multiple clinical and administrative sources. Over a 12-year period, 671 First Nations and 4347 non-First Nations HCV-positive Canadians were identified in the province of Manitoba. Demographics, residence and time trends were compared between infected First Nations and non-First Nations persons.</p><p><strong>Results: </strong>HCV-infected First Nations individuals were younger (mean [± SD] age 33.0±0.4 years versus 39.7±0.2 years; P<0.0001), more often female (60% versus 40%; P<0.0001) and more often resided in urban centres (73% versus 27%; P<0.001). The rate of newly diagnosed HCV cases was 2.5-fold (91.1 per 100,000 versus 36.6 per 100,000; P<0.000) and prevalence 2.4-fold (801.7 per 100,000 versus 334.8 per 100,000; P<0.000) higher among the First Nations relative to non-First Nations populations.</p><p><strong>Conclusions: </strong>The results of the present large population-based study indicate that the First Nations population with hepatitis C is characteristically different from infected non-First Nations persons. The results also describe higher rates of newly diagnosed cases and prevalence of HCV infection in the First Nations population. These findings should serve as an important baseline for future primary prevention and therapeutic intervention strategies in this high-risk population.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 6","pages":"336-40"},"PeriodicalIF":2.7,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/380963","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C virus infection in Canada's First Nations people: a growing problem.","authors":"Matthew D Sadler,&nbsp;Samuel S Lee","doi":"10.1155/2013/641585","DOIUrl":"https://doi.org/10.1155/2013/641585","url":null,"abstract":"As of 2007, it was estimated that 240,000 Canadians were chronically infected with hepatitis C virus (HCV), with higher rates in certain at-risk populations (1). It is possible that this figure underestimates the prevalence of HCV infection, and other estimates are significantly higher (2,3). Unfortunately, firm data regarding national prevalence are lacking. What is clear is that the greatest risk for acute HCV infection is intravenous drug use, which accounts for nearly two-thirds of new cases in Canada (1). Population-based studies on the incidence and prevalence of HCV infection in Canada are sparse. Despite this, there have been several studies that show higher rates of HCV infection in Aboriginal people; however, these studies have only examined high-risk groups within the Aboriginal community such as incarcerated persons and intravenous drug users. \u0000 \u0000In the current issue of the Canadian Journal of Gastroenterology, Uhanova et al (4) (pages 336–340) describe the incidence and prevalence of HCV infection in a Canadian First Nations population. This study is important in that it is the first population-based study to examine HCV infection in this group. The investigators used the Manitoba Health Plan Registry to identify 671 First Nations individuals in Manitoba who tested positive for HCV between 1991 and 2002. The majority of HCV-infected Aboriginal individuals lived in an urban setting despite the fact that most First Nations people were rural habitants. Uhanova et al confirmed previous studies that showed a higher prevalence of HCV in First Nations people compared with non-Aboriginals. Surprisingly, the authors show that more female than male aboriginals acquired HCV in that time period, a trend that is opposite to what has been reported in the non-Aboriginal population (4). It is also concerning that despite a decreasing incidence of HCV infection in the general Canadian population, this study shows that the rate of new HCV infections in the First Nations population is increasing (4). \u0000 \u0000There are, however, a few important limitations to this study. First, the authors did not describe the rate of spontaneous clearance of HCV, which has been shown to occur more frequently in Aboriginals, especially First Nations women (5). The prevalence of HCV in the First Nations population may, therefore, be overestimated due to an inability to ascertain who cleared HCV between 1991 and 1995. Along these same lines, it would be helpful to know the rate of HCV-HIV coinfection in this population because individuals coinfected with HIV are less likely to spontaneously clear HCV (5). \u0000 \u0000Furthermore, the authors did not categorize HCV infection according to genotype. Because HCV genotype has major implications on hepatitis C treatment and rates of clearance with treatment, it would be useful to know whether there are differences in the HCV genotypes acquired by Aboriginals compared with non-Aboriginals. Finally, the definition of First Nations in this stud","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 6","pages":"335"},"PeriodicalIF":2.7,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/641585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative delirium in the intensive care unit predicts worse outcomes in liver transplant recipients.","authors":"Thomas Lescot,&nbsp;Constantine J Karvellas,&nbsp;Prosanto Chaudhury,&nbsp;Jean Tchervenkov,&nbsp;Steven Paraskevas,&nbsp;Jeffrey Barkun,&nbsp;Peter Metrakos,&nbsp;Peter Goldberg,&nbsp;Sheldon Magder","doi":"10.1155/2013/289185","DOIUrl":"https://doi.org/10.1155/2013/289185","url":null,"abstract":"<p><strong>Background: </strong>Delirium is common in intensive care unit patients and is associated with worse outcome.</p><p><strong>Objective: </strong>To identify early risk factors for delirium in patients admitted to the intensive care unit following orthotopic liver transplantation (OLT).</p><p><strong>Methods: </strong>An observational study of patients admitted to the intensive care unit from January 2000 to May 2010 for elective or semi-elective OLT was conducted. The primary end point was delirium in the intensive care unit. Pre- and post-transplantation and intraoperative factors potentially associated with this outcome were examined.</p><p><strong>Results: </strong>Of the 281 patients included in the study, 28 (10.03%) developed delirium in the intensive care unit at a median of two days (interquartile range one to seven days) after OLT. According to multivariate analysis, independent risk factors for delirium were intraoperative transfusion of packed red blood cells (OR 1.15 [95% CI 1.01 to 1.18]), renal replacement therapy during the pretransplantation period (OR 13.12 [95% CI 2.82 to 72.12]) and Acute Physiologic and Health Evaluation (APACHE) II score (OR per unit increase 1.10 [95% CI 1.03 to 1.29]). Using Cox proportional hazards models adjusted for baseline covariates, delirium was associated with an almost twofold risk of remaining in hospital, a fourfold increased risk of dying in hospital and an almost threefold increased rate of death by one year.</p><p><strong>Conclusion: </strong>Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"207-12"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/289185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal cancer surveillance after index colonoscopy: guidance from the Canadian Association of Gastroenterology.","authors":"Desmond Leddin,&nbsp;Robert Enns,&nbsp;Robert Hilsden,&nbsp;Carlo A Fallone,&nbsp;Linda Rabeneck,&nbsp;Daniel C Sadowski,&nbsp;Harminder Singh","doi":"10.1155/2013/232769","DOIUrl":"https://doi.org/10.1155/2013/232769","url":null,"abstract":"<p><strong>Background: </strong>Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.</p><p><strong>Methods: </strong>The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.</p><p><strong>Results: </strong>The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonoscopy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonoscopy at an interval of five to 10 years.</p><p><strong>Discussion: </strong>The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"224-8"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/232769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary teams as standard of care in inflammatory bowel disease.","authors":"Subrata Ghosh","doi":"10.1155/2013/710671","DOIUrl":"https://doi.org/10.1155/2013/710671","url":null,"abstract":"Inflammatory bowel diseases (IBD), ulcerative colitis and Crohn disease have been associated with extraintestinal manifestations. These include arthralgia and arthritis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis and autoimmune hepatitis, episcleritis and uveitis. Increasingly, other conditions, such as psoriasis and multiple sclerosis, have been described to be associated with IBD. It may be proper to consider IBD to be one of a spectrum of immune-mediated inflammatory diseases (IMIDs) clustered according to genetic predisposition and immunological imbalance. In general, IMIDs affect young people at the peak of their working life and, therefore, are associated with a high societal cost (1). Extraintestinal manifestations are important predictors of morbidity and temporary work disability (1). \u0000 \u0000IBD is managed by gastroenterologists and, when required, by colorectal surgeons, but ideally should be managed in the setting of a multidisciplinary team. In the current issue of the Canadian Journal of Gastroenterology, this is illustrated by the report from Maastricht (The Netherlands) by Stolwijk et al (2) (pages 199–205) demonstrating the high prevalence of self-reported musculoskeletal spondyloarthropathy (SpA) in patients with IBD. However, one-half of these patients never consulted a rheumatologist. The population-based cumulative incidence of SpA in Crohn disease is reported to be 6.7% at 10 years, 13.9% at 20 years and 18.6% at 30 years. However, this may have missed patient-reported musculoskeletal symptoms. Lack of rheumatology referral misses an opportunity for accurate diagnosis, appropriate imaging and management strategies. SpA may follow a disease course separate from the activity of IBD and, therefore, may warrant therapeutic strategies dictated by musculoskeletal disease burden and morbidity. These include consideration of nonsteroidal anti-inflammatory drugs (NSAIDs) in the context of IBD, immunosuppressive drugs and anti-tumour necrosis factor (anti-TNF) agents. SpAs are also a group of overlapping, chronic inflammatory rheumatic diseases; therefore, accurate phenotyping is important for management. Musculoskeletal symptoms may also be a side effect of drug therapy in IBD such as delayed hypersensitivity reactions to anti-TNF agents, thiopurines, nutritional deficiencies and corticosteroid withdrawal. Equally important is to recognize that gastrointestinal symptoms in patients with SpA may be a manifestation of IBD and require investigation by a gastroenterologist. \u0000 \u0000In general, the extraintestinal manifestations of IBD and the associated IMIDs respond to anti-TNF therapy, except primary sclerosing cholangitis. However, the use of etanercept may rarely be associated with development of IBD. Etanercept is ineffective in IBD and, therefore, SpA in the presence of IBD should be treated with the anti-TNF monoclonal antibodies. Other IMIDs, such as psoriasis and drug-induced lupus, may manifest while under tre","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"198"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/710671","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of self-reported spondyloarthritis features in a cohort of patients with inflammatory bowel disease.","authors":"Carmen Stolwijk,&nbsp;Marieke Pierik,&nbsp;Robert Landewé,&nbsp;Ad Masclee,&nbsp;Astrid van Tubergen","doi":"10.1155/2013/139702","DOIUrl":"https://doi.org/10.1155/2013/139702","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal symptoms belonging to the spectrum of 'seronegative spondyloarthritis' (SpA) are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and may lead to important disease burden. Patients with suspected SpA should be referred to a rheumatologist for further evaluation.</p><p><strong>Objective: </strong>To investigate the self-reported prevalence of musculoskeletal SpA features in a cohort of patients with IBD and to compare this with actual referrals to a rheumatologist.</p><p><strong>Methods: </strong>Consecutive patients with IBD visiting the outpatient clinic were interviewed by a trained research nurse about possible SpA features using a standardized questionnaire regarding the presence or history of inflammatory back pain, peripheral arthritis, enthesitis, dactylitis, psoriasis, uveitis and response to nonsteroidal anti-inflammatory drugs. All patient files were verified for previous visits to a rheumatologist and any rheumatic diagnosis.</p><p><strong>Results: </strong>At least one musculoskeletal SpA feature was reported by 129 of 350 (36.9%) patients. No significant differences between patients with Crohn disease and ulcerative colitis were found. Review of medical records showed that 66 (51.2%) patients had ever visited a rheumatologist. Axial SpA was diagnosed in 18 (27.3%) patients, peripheral SpA in 20 (30.3%) patients and another rheumatic disorder in 14 (21.2%) patients.</p><p><strong>Conclusion: </strong>Musculoskeletal SpA features are frequently present in patients with IBD. However, a substantial group of patients is not evaluated by a rheumatologist. Gastroenterologists play a key role in early referral of this often debilitating disease.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"199-205"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/139702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunization history of children with inflammatory bowel disease.","authors":"Ing Shian Soon,&nbsp;Jennifer C C deBruyn,&nbsp;Iwona Wrobel","doi":"10.1155/2013/539524","DOIUrl":"https://doi.org/10.1155/2013/539524","url":null,"abstract":"<p><strong>Background: </strong>Protection against vaccine-preventable diseases is important in children with inflammatory bowel disease (IBD) due to frequent immunosuppressive therapy use. The chronic relapsing nature and treatment regimen of IBD may necessitate modified timing of immunizations.</p><p><strong>Objective: </strong>To evaluate the completeness of immunizations in children with IBD.</p><p><strong>Methods: </strong>Immunization records of all children with IBD followed at the Alberta Children's Hospital (Calgary, Alberta) were reviewed. For children with incomplete immunization according to the province of Alberta schedule, the reasons for such were clarified. Demographic data and age at diagnosis were also collected.</p><p><strong>Results: </strong>Immunization records were obtained from 145 (79%) children with IBD. Fifteen children had incomplete routine childhood immunizations, including two with no previous immunizations. The most common incomplete immunizations included hepatitis B (n=9), diphtheria, tetanus, acellular pertussis at 14 to 16 years of age (n=7), and diphtheria, tetanus, acellular pertussis, inactivated polio at four to six years of age (n=6). The reasons for incomplete immunization included use of immunosuppressive therapy at time of scheduled immunization; IBD-related symptoms at time of scheduled immunization; parental refusal; recent move from elsewhere with different immunization schedule; unawareness of routine immunization; and needle phobia.</p><p><strong>Conclusions: </strong>Although the majority of children with IBD had complete childhood immunizations, suboptimal immunizations were present in 10%. With increasing use of immunosuppressive therapy in IBD, physicians caring for children with IBD must periodically evaluate immunization status and ensure the completeness of childhood immunizations.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"213-6"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/539524","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre.","authors":"Adam Isaiah Newman,&nbsp;Shelley Beckstead,&nbsp;David Beking,&nbsp;Susan Finch,&nbsp;Tina Knorr,&nbsp;Carol Lynch,&nbsp;Meredith MacKenzie,&nbsp;Daphne Mayer,&nbsp;Brenda Melles,&nbsp;Ron Shore","doi":"10.1155/2013/515636","DOIUrl":"10.1155/2013/515636","url":null,"abstract":"<p><p>The aim of the present prospective observational study was to assess uptake and success of hepatitis C virus (HCV) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston, Ontario. The Street Health Centre offers hepatitis C education, assessment and treatment within a multidisciplinary, integrated and collaborative treatment model of care delivered by primary care professionals. The study enrolled a convenience sample of 34 patients. Seventy per cent of study patients had no postsecondary education, 85% were unemployed and one-third were unstably housed. A majority of study patients self-reported mental health problems. Of the 14 patients who initiated antiviral treatment in the study period, eight (57%) achieved sustained virological response. Regardless of virological outcome, patients who initiated treatment showed positive trends toward increased social and psychiatric stability, and decreases in high-risk behaviours. These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible, but the benefits of such treatment delivered in a community-based, multidisciplinary, primary care model may extend beyond narrowly defined virological outcomes.</p>","PeriodicalId":55285,"journal":{"name":"Canadian Journal of Gastroenterology","volume":"27 4","pages":"217-23"},"PeriodicalIF":2.7,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2013/515636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31383886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}